Indian J Crit Care Med 2020;24(10)971-974.Coronavirus disease-2019 (COVID-19) causes severe hypoxemia which fulfills the criteria of acute respiratory distress syndrome (ARDS) but is not accompanied by typical features of the syndrome. The combination of factors including low P/F ratios, high A-a gradient, relatively preserved lung mechanics, and normal pulmonary pressures may imply a process occurring on the vascular side of the alveolar-capillary unit. The scant but rapidly evolving data available on the pathophysiology are seemingly conflicting, indicating the relative dominance of intrapulmonary shunting or dead space in different studies. In this hypothesis paper, we attempt to gather and explain these observations within a unified conceptual framework by invoking the relative contributions of microvascular thrombosis, along with two proposed vascular mechanisms of capillary flow redistribution and flow through intrapulmonary arteriovenous anastomoses (IPAVA). How to cite this article Nitsure M, Sarangi B, Shankar GH, Reddy VS, Walimbe A, Sharma V, et al. Mechanisms of Hypoxia in COVID-19 Patients A Pathophysiologic Reflection. Indian J Crit Care Med 2020;24(10)967-970.Reporting ventilator-free days (VFDs) with time frame of 28 days is a popular composite outcome measure (COM) in trials. However, early deaths and shorter pediatric intensive care unit (PICU) stay predominate in low- and middle-income countries (LMICs). https://www.selleckchem.com/products/tapi-1.html A shorter time frame may reduce sample size required. We planned to compute sample size requirements for different effect sizes from datasets of previously conducted prospective studies for 28-day and 14-day time frames (VFDvs VFD) to examine the hypothesis.
The VFDand VFDwere defined. Datasets of five prospective studies from PICU of our hospital were analyzed to estimate sample sizes for target reductions of 1-9 days in VFDs and other COMs for the two time frames. Reconfirmation of results was done with datasets of two other studies from PICUs of two geographical extremes of the country.
Time-to-event occurred within 14 days in majority of patients. Sample size required for VFDis about one-fifth to one-sixth of what is required for VFDfor target reductions of 1-9 days for all the enrolled studies. The same was true for other COMs as well. The hypothesis was supported by datasets of two other studies used for reconfirmation.
Choice of time frame for assessing VFDs and other COMs in clinical trials should be guided by the clinical context. A shorter time frame may be rewarding in terms of smaller sample size in the prevalent clinical setting of LMICs. Further confirmation with more datasets and prospective studies is desirable.
Baranwal AK, Kumar MP, Gupta PK. Comparison of Ventilator-free Days at 14 and 28 days as a Clinical Trial Outcome in Low- and Middle-income Countries. Indian J Crit Care Med 2020;24(10)960-966.
Baranwal AK, Kumar MP, Gupta PK. Comparison of Ventilator-free Days at 14 and 28 days as a Clinical Trial Outcome in Low- and Middle-income Countries. Indian J Crit Care Med 2020;24(10)960-966.Delirium is a fluctuating cognitive disorder that occurs in admitted patients, especially in patients who are in intensive care units. Nurses due to persistent contact with patients and direct observation of their mental changes play an essential role in delirium evaluation. Early detection of delirium, identification of risk factors, and its prevention methods are critical to reducing complications, mortality, and treatment costs. This study aimed to determine the perception and the practices of nurses in intensive care units to assess delirium and its barriers.
A cross-sectional study.
All nurses working in the intensive care unit (neurology, trauma, surgery, general, and heart) of educational hospitals in Kerman, Iran, were the study population. The data gathering tool was a questionnaire consisting of four sections demographic information, nurses' perception, practices, and perceived barriers in delirium assessment.
The total score of nurses' perception in delirium assessment was 19.47 ± 3.36, whi10)955-959.To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand.
The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptation guidelines. After reliability and validity testing, we consecutively surveyed the satisfaction of family members of ICU patients over 1 year. Adult family members of patients admitted to medical or surgical ICUs for 48 hours or more who had visited the patients at least once during the ICU stay were included.
In all, 315 (95%) of 332 surveys were returned from family members. Cronbach's α of the Thai FS-ICU 24 questionnaire was 0.95. Factor analysis demonstrated good construct validity. The mean (±SD) of total satisfaction score, overall ICU care subscale, and decision-making subscale were 81.5 ± 14.3, 81.0 ± 15.6, and 82.0 ± 14.0. Items with the lowest scores were the waiting room atmosphereJ Crit Care Med 2020;24(10)946-954.is an important cause of bacteremia and infective endocarditis in adults. Studies from other parts of the world have shown a strong association between bacteremia and colonic neoplasia. The profile of bacteremia is understudied in Indian population.
We retrospectively analyzed the data of 16 patients with bacteremia obtained from microbiology registry. BacT/ALERT positive samples were inoculated into blood agar, chocolate agar, and MacConkey agar. Organisms were identified by the VITEK 2 microbial identification system, and susceptibility was done by the microbroth dilution method as per Clinical and Laboratory Standards Institute (CLSI) M100 guidelines. Clinical details were obtained from electronic medical records.
Majority of our isolates were subspecies . Total 16 patients had isolated from blood over a 1 year period. The median age was 58 years (IQR 46.5-66). Eleven were males; type II diabetes mellitus and chronic liver disease were the common comorbidities observed in our patients.